Agave Syrup and Diabetes: New Things to Know

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Agave
enjoyed a huge boom around 2010, when everyone seemed to be shouting
from the rooftops about what a great natural sweetener it was,
especially ideal for people with diabetes. NOT.

We looked into it, both then and more recently, and what we found was pretty interesting.

Of course, a lot of people are down on the chemical content of those familiar little packets of artificial sweeteners -- Equal, Sweet N' Low and Splenda -- so they’re turning to plant-based alternatives, like agave and stevia.

What is Agave Syrup/Nectar?

Agave nectar is made from various types of agave plants, which are found in southern Mexico. The consistency and even the taste are comparable to honey. Interesting fact: If you ferment the blue agave plant, it actually turns into tequila (wow!). Otherwise, agave can be used to create a sweet syrup or "nectar" (the latter term certainly sounds more benign and natural!)

Angela Ginn, a Certified Diabetes Educator (CDE) and National Spokesperson for The Academy of Nutrition and Dietetics, explains: “Agave is a nutritive sweetener that contains carbohydrate, vitamins and minerals such as iron, calcium, potassium and magnesium and calories. The difference in the color of various types is due to the filtration of salts and minerals in production.”

For a long time, many health food advocates believed agave was a perfect solution for PWDs (people with diabetes) because it's made of up to 90% fructose rather than sucrose, so it's much lower on the glycemic index (GI) and thus doesn't pack the same immediate punch to blood glucose levels as table sugar.

But that, as we learned, may be misleading. While it’s generally true that the lower a food’s GI score, the slower it raises blood sugar, it’s also well-documented that basing a food’s healthfulness on the glycemic index is misguided -- given that ice cream ranks lower than watermelon.

Healthy and Natural - Raw Agave?

Beware that agave syrup is hardly a “free food.” A teaspoon comes with 20 calories and 5 grams of carbs — slow-releasing carbs, yes, but they're still there. In comparison, one teaspoon of regular sugar is 16 calories and 4 carbs. And the calories, for anyone watching their weight, can still add up if you're not careful.

On top of that, agave’s praise for being a “natural” sweetener appears to be misleading too. It turns out the distilled nectar is highly processed using chemicals and GMO enzymes. In fact, some consumer advocates were horrified to learn that the process often uses an enzyme derived from mold (Aspergillus Niger). Crazy!

And what about so-called “raw agave”? Turns out it is simply processed at a lower temperature in order to retain some of the nutrients lost at high temperatures.

According to Joanne Rinker, the American Association of Diabetes Educators’ (AADE) pick for diabetes educator of the year in 2013: “Raw agave nectar has a more mild, neutral taste. It is produced at temperatures below 115°F to protect the natural enzymes and retains a healthy pre-biotic substance called inulin, which provides the food for healthy pro-biotic bacteria to eat. That may be the only real difference or benefit.”

What’s the Glycemic Index of Agave Nectar?

The big selling point of agave is of course its low Glycemic Index measure. Just how low?

Nutrition and Dietetics expert Ginn tells us the GI measure of agave nectar is 32, which is rather low on the 0-100 scale -- therefore it may well have a lesser effect in spiking your blood glucose.

“However, agave contains fructose and glucose similar to High Fructose Corn Syrup (HFCS). The common concern from consumers is that HFCS may be associated with obesity and insulin resistance in adults,” she adds.

When people choose processed foods that contain fructose, like agave, it is metabolized very differently, and specific to diabetes, it can lead to insulin resistance. So, although the GI (Glycemic Index) may be low, the impact is potentially harmful!

Joanne Rinker, 2013 AADE Diabetes Educator of the Year

Fructose, High Fructose Corn Syrup, and Diabetes

Let’s talk about fructose for a moment... That's the natural sugar in fruit, right?

Yes, but according to research, fructose found in fruit is perfectly fine, while fructose found in processed foods, like agave syrup, can have some seriously negative health effects.

Dr. Ingrid Kohlstadt, a Johns Hopkins professor and fellow of the American College of Nutrition, recently told the Chicago Tribune: "Fructose interferes with healthy metabolism when taken at higher doses. Many people have fructose intolerance like lactose intolerance. They get acne or worse diabetes symptoms even though blood glucose is OK."

Many agave brands contain 70-95% fructose, whereas even HFCS itself contains just about 55%, while a piece of whole fresh fruit contains just 5-6%.

She explains that large doses of fructose are harsh on the liver, which when forced to metabolize it, develops a syndrome called fatty liver, which contributes to chronic liver disease called cirrhosis. Basically, the fructose is converted into triglycerides which get stored as white adipose tissue (fat) -- the kind of fat that the body CANNOT use for energy. All bad.

There's a lot of research on the negative effects of fructose, including evidence that fructose-sweetened beverages can cause weight gain and insulin resistance — certainly things we PWDs want to avoid!

The Research on Agave Says…

Surprisingly, there is very little research on agave, or on the use of sweeteners in general. This fact was corroborated by all the experts we queried.

In short, there just isn’t any research specific to agave syrup. But according to Rinker, “the overall message (from the health and medical community) is that the GI is low and the fructose is high, at 90% vs. 50% for sugar.” And we’ve already established that high fructose is bad.

Cooking and Baking with Agave

Some PWDs report that they do enjoy and benefit from agave. Jeff Cohen, a type 2, shared in an online forum: "I've had great success with agave. I also like the appealing taste, something most other sweeteners don't provide." He points out that most of the warnings he's seen were for a few particular brands of agave — Volcanic Nectar — accused of adding "fillers" like maltose, which have their own long list of ill effects. Jeff believes that "not all agave should be written off."

Yet many others disagree. Brian Cohen, a type 2 known in the Diabetes Community for his healthy cooking skills and enthusiasm, says he’s definitely not a fan. “My understanding is that agave syrup and nectar are different, agave syrup is closer to table sugar while agave nectar can be nearly 90% fructose. I suspect that out in the real world, agave syrup would have about the same effect on blood sugars as table sugar… Personally I never buy or use anything with a high fructose content like agave syrup/nectar.”

“I have found that other sweeteners such as stevia, sugar alcohols (my favorites are Xylitol and Erythritol) or even sucralose (Splenda) can sometimes have a different, slightly bitter taste, but I don’t think it noticeably affects dishes,” he adds.

Still, one noted advantage of agave is that it is extremely concentrated, so you can use a fraction of the amount in a recipe as you would with other sweeteners.

The taste is sweeter than sugar, so 1/3 cup of agave would be compared to 1 cup of sugar. When living with diabetes the recommendation is Moderation.

Angela Ginn, Certified Diabetes Educator (CDE) and National Spokesperson for The Academy of Nutrition and Dietetics

The AADE’s Rinker agrees: “What’s most important is how much of any sweetener we are consuming.We should be limiting them to no more than 4-9 tsp per day (less than 10% of total calories). This includes agave, sugar, brown sugar, etc.”

She provides some helpful details on how PWDs should think about agave:

“Agave is 1.5 times sweeter than sugar so the idea is that a person who chooses this may be able to use less to get the desired sweetness then they would with regular sugar. If this helps a person cut back from 6 tsp to 4 tsp, for example, then this may be a great alternative. But, if a person assumes that if they choose this sweetener they can have a larger portion then that is not the case, as it will still affect blood sugar.”

“Agave nectar has 5g of carbohydrate and 15 calories per teaspoon and that is actually higher than regular sugar, which is 4g and 16 calories. Agave syrup is processed, it is higher in calories and it still contains carbohydrates and needs to be counted just like any other carbohydrate. The benefit may be that you can use less for the same desired sweetness. That may make it ‘better’ than some alternatives, but it would come down to personal preference.“

"Agave is lower GI but high in fructose, and it does have a unique taste that chefs can desire for flavor. I tend to use different natural sweeteners in my cooking -- coconut sugar, honey etc. -- depending on desired texture and flavor layers."

Best Sweeteners for People with Diabetes

So with all that said about agave, what’s the best sweetener choice for people with diabetes?

There is no one definitive answer.

CDE Joanne Rinker reminds us that the American Diabetes Association lists agave with table sugar, brown sugar, honey, maple syrup and all other sugars. “If a person was really looking for the healthiest option from this list, the answer may be local honey. If that was the sweetener of choice, they would still have to be aware of portion sizes, but they would have the added benefits of antioxidants, phytonutrients and allergy protection,” she says.

If you’re looking for another truly raw and natural option, many health food advocates recommend date sugar, which can also be made into a paste suitable for baking. Different varieties of dates have a Glycemic Index score in the 43 to 55 range, but without the high fructose or chemical processing drawbacks of agave.

Nutritive sweeteners contain carbohydrates and provide energy. They occur naturally in foods or may be added in food processing or by consumers.

NNS are those that sweeten with minimal or no carbohydrates or energy. They are regulated by the FDA as food additives and generally recognized as safe.

Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications.

Other suggestions are stevia, coconut palm sugar, coconut nectar, and yacon syrup, made from the root of the yacon plant, which grows in the Andes region of South America. Yacon is actually reported to have health benefits to your gut: it’s a prebiotic the aids in the absorption of calcium and other vitamins, and promotes healthy gut flora, which are essential for good digestion.

Some final words of wisdom from T2 foodie Brian Cohen: “Many of us seek a way of sweetening our baking or cooking without incurring high blood sugars. There are literally dozens of alternatives to table sugar, many which have really small or negligible effects on our blood sugars. But many of those alternatives may have their own adverse effects, so it is important to try to read up (from credible sources) and make informed choices about which alternative sweeteners to use.”

Disclaimer: Content created by the Diabetes Mine team. For more
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
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Thanks for a great article! My dad has been trying to push this on me for a long time, and my research has turned up much of the same things!

Jen|2011-12-15

My experience with Agave nectar has put me off of it completely. I started using it a couple of years ago--I was thrilled that I could bake with it and it didn't seem to spike my husband's blood sugar (I don't care for the taste of Splenda or any of the other chemical sweeteners.) So what was the problem? I gained belly fat--and quickly. The agave was the only thing in my diet that had changed: exercise and everything else stayed the same.I started doing some reading and came to the conclusion that it is as bad, if not worse than, HFCS. I stopped using it, and the belly fat did come off. I pitched what we had left, which was painful because that stuff is expensive.

Chris|2011-12-15

I still use locally produced honey for recipes along with stuff like mashed bananas and apples. They work great. For my sports drinks, stevia does the job. Great article BTW!

Sally|2011-12-15

I've tried here. Here in Texas, Agave is pretty common. A lot of my friends have been after me to swap to it. My research really hasn't impressed me. Sugar is sugar, regardless of the source. It hasn't been the first time the "healthier alternative" has wound up being the opposite.Eating in moderation? All around win.

kim|2011-12-15

normally i don't use any sweetener. i tried stevia, and it is tooo bitter for my taste. if i need to sweeten my tea or coffee, i will just use regular sugar and include it as part of my meal and bolus for it.

Stead|2011-12-15

Great article. Very interesting.

KhÃ¼rt Williams|2011-12-15

"If you ferment the blue agave plant, it actually turns into tequila "Actually it turns into mescal. Tequila is mescal that comes from the city of Tequila in western Mexican state of Jalisco. http://en.wikipedia.org/wiki/TequilaI've know about the sugary nature of agave nectar/syrup for quite some time. I simply read the lablel."It's almost all fructose, which is just highly processed sugar with great marketing,"Quite right!!!

Hannah McD|2011-12-15

My very dear friend gags at the mere mention of artificial sweeteners and will practically gag if she's found out she just consumed something that might have a trace of it. While she doesn't judge me, she does look a bit uncomfortable if I drink diet Coke around her.She's been dieting recently on a plan that calls for no refined sugars at all, but she'll still put agave in things now and then. She will cook with maple syrup (the real stuff) and has recently purchased palm sugar and date sugar. When I look at any of the nutrition ingredients, all I see are carbs. Carbs carbs carbs. I don't know what to do about making things sweet anymore. I tried to get some sugar that's organic, not bleachy white, and isn't supposed to be totally refined, but you never know. Just because it's organic doesn't mean it's great for you. *chomps on organic tortilla chips just to make a point*

Natalie|2011-12-15

At the AADE convention in Las Vegas last August, I attended 2 different presentations about diet, and specifically, sugars. One thing that BOTH presenters were very definite about is that processed fructose is bad for EVERYONE, not just diabetics. There is no cell in the body that uses fructose for fuel, so the liver converts it ALL to triglycerides and VLDL, and that means one thing -- FAT. Even excess glucose (like when your BG is high) gets converted into triglycerides and VLDL. This effect on triglycerides has been confirmed by papers on heart disease, which something we are prone to, as diabetics, anyway (sorry for not having the cites). Agave syrup is absolutely the WORST thing we could put in our bodies -- ANY artificial sweetener is better. And sucrose is no different from high-fructose corn syrup -- they're both about 50-50 glucose and fructose. So it looks to me like artificial sweeteners, which by now, have been in use for MANY years, are safer than fructose or sucrose. In Canada, cyclamates NEVER became illegal, and they have been in use for more than 50 years, and there are STILL no reports of ill effects. It's time to stop the hysteria over sweeteners and pay attention to the scientific evidence.

Jessica Apple|2011-12-16

Agave is really not healthy. I took me too long to figure that out. Thanks for the post.

Diabetic Survival Kit|2011-12-16

People need to read labels and rely on good solid evidence before eating anything. You commented about the safety of stevia. How long has it been out and are there any studies showing it is better than the others that have been available for many years?

Doug|2011-12-16

In an attempt to lower the quantity of declarative over reactions here... I'll add that if you like margaritas, and have had BG problems from them. My experience is that tequila, agave nectar and lime juice over ice makes a tasty margarita that doesnt spike my BG nearly as much as others. Milagro tequila is giving away a bottle of nectar in gift packs with their silver tequila. As far as belly fat or conversion to lipids, I found 25 years ago in my first T1 diet class that ANYTHING that tastes good is not good for you, if its low sugar its high fat, or high sodium and vice versa. So everything in moderation .... ( I know that alcohol is bad.... Im a sinner with a 20+ year record of a1cs under 7 )I'm LOLing that " Agave syrup is absolutely the WORST thing we could put in our bodies " really ? LOL Wow...

CJ|2011-12-16

I am curious how fructose from fruit is "perfectly fine" but fructose from corn syrup and agave nectar converts to triglycerides. Isn't the fructose in both chemically the same or is there a difference? If anyone has an explaination I am quite interested.Also, I find xylitol (Xyla) to be a great tasting sweetener with minimal effects on my blood sugar. The only side effect that I have seen is that it can cause intestinal discomfort when eaten in larger quantities (I haven't experienced this yet). The label on xyla says its "safe for diabetics since it is metabolized independently of insulin" however a book I read says sugar alcohols do affect blood sugar, just not as much as sugar. Does anyone know a good source that can accurately clarify this? I find that in general, I am constantly running into conflicting information when it come to diabetes and food that are safe/not safe and low/high glycemic load.

Natalie|2011-12-16

CJ, the scientists that I heard at the AADE specifically noted that there is no evidence one way or the other about the fructose in fruit. But fruit has other nutritional benefits, whereas agave syrup has none. And, Doug, yes, I misstated when I said agave syrup was the worst thing we could put in our bodies. What I was thinking was that agave syrup is the worst SWEETENER we could put in our bodies, but what the mind thinks and what the fingers type can be 2 different things, especially when you're a fast typist, LOL!!

rita NJ|2011-12-17

I use Agave and have for almost a year. I can't use artifical sweeteners because of the affects they cause. Iused them for years and had sever IBS from the use. I find Agave works for me. The taste is pleasant, I use only a quarter of a teaspoon in tea and it has helped curb my IBS symptoms. I can't say it is healthy but it beats a full teaspoon of sugar and lets face it, any overindulgence in anything isn't good. OH! and my fasting sugar is 101 so I am fine.

CJ|2011-12-17

Keep in mind that triglycerides are stored and can then be broken down for energy later. It seems that someone who eats a healthy diet that's low fat and low sugar with a modest amount of agave syrup (or any fructose for that matter), and exercises regularly is at a pretty low risk of becoming obese and developing complications. I am still confused why fructose in fruit is okay? All the research I find discusses high fructose corn syrup, soda, and fruit juice but never mentions fruit. Perhaps its the fiber in fruit that helps, or perhaps no one wants to make the claim that to much fruit can be unhealthy??

CJ|2011-12-17

Although fructose, as well as other sugars are converted to triglycerides, they are stored as energy and can be used/burned later (via exercise). So someone who eats a healthy low fat and sugar diet, eats modest amount of agave (or any form of fructose for that matter), and excercises regularley should have a low risk of obesity and other ill health effects. I still can't figure out why fructose from fruit is okay. All the studies I see reference high fructose corn syrup and sucrose. Perhaps the fiber in fruit helps, or no one wants to make the claim that fruit is unhealthful?

Dave|2011-12-21

I'll just stick with Splenda, thanks. Great article and drives home the point that for people trying to avoid sugar there are many pitfalls to be avoided as well.

Judy|2011-12-21

Very interesting article

eve|2011-12-21

I try to avoid using agave. I don't give my son any artificial sweeteners. I use small amounts of organic maple syrup, raw honey, bananas or unsweetened applesauce.